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Gallstone pancreatitis — RCPSC IM MCQ

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HardGastroenterology/HepatologyGallstone pancreatitisRCPSC IM

A patient with gallstone pancreatitis is improving, but bilirubin and alkaline phosphatase remain elevated without cholangitis and ultrasound does not show a duct stone. What is the best next step?

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Correct answer: A — Use MRCP or endoscopic ultrasound for a retained duct stone

The best answer is “Use MRCP or endoscopic ultrasound for a retained duct stone”. Persistent cholestasis without cholangitis warrants noninvasive or minimally invasive evaluation for a retained duct stone. ERCP is reserved for cholangitis or a demonstrated/high-likelihood obstruction because it carries procedural risk. If cholangitis or persistent high-probability obstruction develops, the balance changes and therapeutic ERCP becomes urgent rather than elective.

Reference: Canadian Association of Gastroenterology guideline library: https://www.cag-acg.org/guideline-library.html